Intravenous Methylprednisolone Pulse Therapy in the Treatment of Graves' Ophthalmopathy

Abstract

Graves' ophthalmopathy (GO) is a specific immune-mediated disorder, whose treatment is sometimes difficult. In order to investigate the efficacy of intravenous methylprednisolone (MP) pulse therapy in GO, we studied eight patients with GO, followed up for at least 6 months by clinical patient self-assessment, ophthalmological examination and orbital computed tomography (OCT). A 12.5 mg/kg dose of MP was administered intravenously over a 10 hour period, once every month. Three to six MP pulse administrations were performed in each patient. All patients were outpatients. A 0.5 mg/kg/day oral prednisone dose was given to each patient as interpulse therapy. Clinical assessment of MP pulse therapy showed a good response in 87.5% and no response in 12.5% of patients. The treatment was rapidly efficient, mostly on patient self-assessment, soft tissue inflammation, ophthalmoplegia, corneal involvement, visual acuity and extraocular muscle enlargement on OCT. Post-treatment ophthalmic index was significantly improved (6.75 +/- 3.06 vs. 2.5 +/- 1.41: p < 0.05). MP pulse therapy had less effect on proptosis (22.94 +/- 2.32 mm vs. 21.56 +/- 2.22 mm: p < 0.05). No adverse effects were noted with MP pulse therapy. Patients showed no relapse of eye involvement during a mean follow up of 31.8 months (2-77 months). In conclusion, our results suggest that intravenous MP pulse therapy is a good immunosuppressive therapy for GO. Moreover, in comparison with the previous studies, the MP dose used in our present study appears to be optimal with high efficacy. MP pulse therapy represents a safe and efficient treatment in GO, which can easily be performed in outpatients.

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

“…response rate of approximately 70 -80% in patients treated intravenously and approximately 50 -60% in those treated orally (53,54). In vitro studies have shown that GCs decrease the production of glycosaminoglycans by orbital fibroblasts, downregulate some cytokine and antibody secretion, modulate T-and B-cell functions, and decrease trafficking of neutrophils and macrophages at the inflammation sites (14, 55) (Fig.…”

“…Intravenous pulsed methylprednisolone is more effective (14,46,57,61) and has a better safety profile compared with oral prednisone (60,61,62,63,64,65). Different treatment schedules have been used, with cumulative doses ranging from 4.5 to 12 g and occasionally associated with oral GC interpulse or at the end of the protocol (3,14,54,55,56,57,58,59). A recent multicenter randomized EUGOGO study has shown that a cumulative dose of 7.5 g of methylprednisolone is more effective than intermediate or lower doses (5 or 2.25 g respectively), although it is associated with more frequent adverse events (65).…”

Effect of High Dose Methylprednisolone Pulse Therapy Followed by Oral Prednisolone Administration on the Production of Anti-TSH Receptor Antibodies and Clinical Outcome in Graves' Disease

“…Exceptionally large amounts of glucocorticoids are used for Graves' patients with severe ophthalmopathy. In these cases, the high dose of intravenous methylprednisolone pulse therapy (pulse therapy) often improves ophthalmic symptoms [4][5][6][7][8][9][10][11][12][13][14][15].…”

Factors associated with outcome after combined steroid and orbital radiotherapy on Graves’ ophthalmopathy

“…27 Matejka et al investigated the efficacy of IVGC pulse therapy (a 12.5 mg/kg dose of MP once every month) on TAO in eight patients. 28 They followed up for at least 6 months by clinical ophthalmological examination. They concluded that MP pulse therapy had less effect on proptosis, though affected eyes were improved from 22.94±2.32 mm to 21.56±2.22 mm (P<0.05) (2-77 months).…”